The Rise of Antibiotic Resistance

In 1773, John Harrison received £8,750 from parliament (albeit not the full "Longitude Prize" of £20,000 [about $4.25million today] that had been offered in 1714) for the chronometer he delivered. Until the advent of GPS in the 1970s, it was descendants of his timepieces that permitted navigators for 200 years to know where they were in the world.

The U.S. embraced a different model, preferring to let the market drive innovation, rather than waiting for our Legislature to post a prize for solving a problem that it deems worthy. For 200yrs, this patent system of granting a period of market exclusivity in exchange for educating your competitors in your innovation has driven a lot of medicine.

But the emergence of antibiotic resistance has revealed the limits of market-driven drug discovery. Twenty years of market exclusivity is a weak incentive to spend the time and money to research and develop a drug that our FDA will reserve for only the direst cases. The drug company will never recuperate its costs that way unless each dose were astronomically expensive. And so we return to the age of government prizes driving innovation at best--or, if our government doesn't act--to a world in which we all risk death from a trivial injury or infection.

The Rise of Antibiotic Resistance

The growth of antibiotic-resistant pathogens means that in ever more cases, standard treatments no longer work, infections are harder or impossible to control, the risk of spreading infections to others is increased, and illnesses and hospital stays are prolonged.The World Health Organization has surveyed the growth of antibiotic-resistant germs around the world — the first such survey it has ever conducted — and come up with disturbing findings. In a report issued late last month, the organization found that antimicrobial resistance in bacteria (the main focus of the report), fungi, viruses and parasites is an increasingly serious threat in every part of the world. “A problem so serious that it threatens the achievements of modern medicine,” the organization said. “A post-antibiotic era, in which common infections and minor injuries can kill, far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”

All of these drive up the costs of illnesses and the risk of death. The survey sought to determine the scope of the problem by asking countries to submit their most recent surveillance data (114 did so). Unfortunately, the data was glaringly incomplete because few countries track and monitor antibiotic resistance comprehensively, and there is no standard methodology for doing so.

Still, it is clear that major resistance problems have already developed, both for antibiotics that are used routinely and for those deemed “last resort” treatments to cure people when all else has failed.

Carbapenem antibiotics, a class of drugs used as a last resort to treat life-threatening infections caused by a common intestinal bacterium, have failed to work in more than half the people treated in some countries. The bacterium is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, and infections in newborns and intensive-care patients. Similarly, the failure of a last-resort treatment for gonorrhea has been confirmed in 10 countries, including many with advanced health care systems, such as Australia, Canada, France, Sweden and Britain. And resistance to a class of antibiotics that is routinely used to treat urinary tract infections caused by E. coli is widespread; in some countries the drugs are now ineffective in more than half of the patients treated. This sobering report is intended to kick-start a global campaign to develop tools and standards to track drug resistance, measure its health and economic impact, and design solutions.

The most urgent need is to minimize the overuse of antibiotics in medicine and agriculture, which accelerates the development of resistant strains. In the United States, the Food and Drug Administration has issued voluntary guidelines calling on drug companies, animal producers and veterinarians to stop indiscriminately using antibiotics that are important for treating humans on livestock; the drug companies have said they will comply. But the agency, shortsightedly, has appealed a court order requiring it to ban the use of penicillin and two forms of tetracycline by animal producers to promote growth unless they provide proof that it will not promote drug-resistant microbes.

The pharmaceutical industry needs to be encouraged to develop new antibiotics to supplement those that are losing their effectiveness. The Royal Pharmaceutical Society, which represents pharmacists in Britain,called this month for stronger financial incentives. It said that no new class of antibiotics has been discovered since 1987, largely because the financial returns for finding new classes of antibiotics are too low. Unlike lucrative drugs to treat chronic diseases like cancer and cardiovascular ailments, antibiotics are typically taken for a short period of time, and any new drug is apt to be used sparingly and held in reserve to treat patients resistant to existing drugs.

Antibiotics have transformed medicine and saved countless lives over the past seven decades. Now, rampant overuse and the lack of new drugs in the pipeline threatens to undermine their effectiveness.